Project Summary Obtaining proper biomechanical stability to promote healing is a primary goal of fracture fixation surgical procedures. Subpar fracture fixation can result in fracture nonunion, residual deformity, implant failure, disuse atrophy, osteopenia, and short or long-term disability. Patients present with variable fracture geometries, bone quality, activity level. Surgeons have many choices for implant types, sizes, materials, construct configurations, and postoperative weightbearing strategies. All these factors, as well as the patient?s innate fracture healing capacity, affect postoperative biomechanics and resulting clinical outcome. Community orthopaedic surgeons who are not trauma specialists often need to treat these fractures. Although surgical technique has received much attention in the medical simulation literature, there is increased recognition of the importance of simulation in the cognitive and decision-making aspects of surgery. The proposed project develops and tests a new interactive simulation software that enables a surgeon to make changes to patient variables and fracture fixation plan, and immediately visualize how these changes affect clinically important 3D biomechanics. The technology is enabled by our high-throughput simulation approaches for generation of precomputed results libraries. The project relies on close long-term collaborations between academic biomedical engineers and clinician scientists, enhanced by collaboration with a leading open-source visualization software research and development organization. The project tests the hypothesis that interactive visualization of 3D biomechanics in fracture fixation will improve biomechanical knowledge and fracture fixation plans. Specific Aim 1 develops and tests effectiveness of a refined simulation software, combined with an instructor-led session, for education of 3D fracture fixation biomechanics. The rich interface will include validated parametric simulations of three fundamental fracture fixation types (bridge plating, compression plating, and intramedullary nailing) applied to both simplified bones and to proximal femur fractures. Specific Aim 2 introduces an autonomous, adaptive virtual coach integrated into the software. The virtual coach will enable flexible, personalized training for each surgeon based on their progress. The project will provide new, exciting opportunities for providing deeper biomechanical understanding to the surgeons who create fracture fixation constructs, facilitating precision medicine and promoting safer and more effective surgical procedures.